ADHD & Mania, Part 2

• I need help on a paper, is anyone able to give me suggestion about linking ADHD, conduct disorder and antisocial personality? jholsinf@mato.com by (No author), 3/17/97
  
  

8) A related phenomenon is that of delayed sleep onset being commonly but not consistently associated with taking a psychostimulant at 3 or 4 P.M. The medication should be out of the child's system by bedtime; yet sleep onset is still delayed. Mania could account not only for the behavior being treated with a stimulant but also for lack of sleep when the medication has left the child's system. Again, is it the persistent ones or those with family histories of domineering behavior who show these sleep disruptions? Nadeau (1996) cites clinical lore that sleep deprivation increases ADHD. It is, however, more likely to affect mania. Too little sleep revs some people to higher levels of energy; too much sometimes has the opposite effect. A recurrent scene is that of a determined child arguing his parents into a later bedtime for Friday or Saturday. He's then more energetic and irritable on Sunday and perhaps into Monday even while bragging to his buddies about how late he was up and what he watched.

9) There can be extreme depression in some children as stimulants leave the blood; some research suggests these valleys are no worse than baseline. Anecdotal parental reports differ. A manic child, more than an ADHD child, could be more sensitive to mood changes that are correlated with the time course of a psychostimulant.

10) Parent training and behavior modification are significant components of ADHD treatment; these elements might also shift their content for manic children. The parents are still confused by our drawing the ADHD model that includes data that ADHD will respond positively to stimulants as much as 90% of the time. Yet, their child is still oppositional and domineering even though the ADHD is treated. Signals and consequences for a manic child may be more effective if they incorporate whatever obsessions he has about power, money, friends, or possessions. Let him hit "therapeutic walls" when he pushes too hard to get his way with other people. Rescuing him from a determined teacher, vice-principal, or police officer may not be the best thing for the child's long-term good. Given possible ties between dominance and mating, parents might be cautioned to expect more sexual activity from their child in puberty. I suspect we clinicians currently fudge things by asserting the need for parent training if things don't work well with the psychostimulant. We also blame parental inconsistency when parent training doesn't work well. We also escape with "prolonged history of partial reinforcement and resistance to extinction," a plausible and useful model but one that omits consideration of mania.

12) There's the "hyperfocus myth" that Ned Hallowell attributed to ADHD and even appears in Nadeau (1996). I think "hyperfocus" more properly fits with other mania symptoms that I see and that Jamison (1996) describes so well. I sometimes wonder if a little mania is an essential for completing either Harvard or medical school!

13) DSM 4 allows possibility of "Hyperactive but no attention problems" ChADD 1996 presentations from several scholars aver that this group is composed of preschoolers who will all be inattentive in a few years. They could also be manic.

14) There are suggestions that ADHD clients die younger (Barkley 1996); the data are consistent with a pattern of life that ignores preventive health measures and temperate driving or vocational habits. ADHD or mania fit that pattern.

15) A recent news release cited data that people using car phones are 4 times as likely to have accidents as non-users. This is the same increase that has been cited for ADHD and automobile accidents. Do we attribute the increase to ADHD or to mania? Manics, if driven by power and financial success, could be more intent on beating deadlines and closing deals, even to the extent of driving 80 while talking on a telephone. (ADHD kids don't particulary need the car phone; they can have plenty of accidents while changing their CD player!)

16) Barkley (1996) speculates that artistic performances in the theater or with expressionist painting might be strong points for ADHD adults or children. Yet, an ADHD client ought to "bore" with the repetitive nature of theater roles; it is also difficult and can require incredible persistence and plannning to execute a good abstract painting. A manic obsession surely is more plausible with either endeavor.

Discussion:

Much of the foregoing views mania as an exaggeration of behaviors related to dominance. Some models may describe mania as an enhancement of any active behavior, an enhancement that is driven by the seasons, sleep patterns, or internal cycles. Because dominance and rivalry issues are common in children and adolescence, those traits are conspicuous because they happen to be the developmental challenges of the moment. I suspect, however, that the dominance themes continue well into adulthood for many manics.

Cantwell (1995) has suggested that environmental triggers may be more common that is usually suspected. Adults certainly respond to job failures and successes or romantic losses and victories with exaggerated despondency or elation. Beck (1988) is likely correct when he suggests that falling in love is basically a manic episode. Winning and losing have highly personal meanings for different people, yet the core idea of "being the best" appears a common foundation for elation or for despair.

There remains the problem of why behavior routines associated with dominance, getting money, gathering the best property, winning at Nintendo, and building things are comparatively intact in some ADHD children and lacking in others. Or, why these skills are intact but there are impairments in doing grammar and interacting appropriately with other people.

Pennington (1991) has suggested that more recently evolved CNS functions are more sensitive to disruption; older systems have greater amounts of resilience. The executive functions of planning, memory retrieval, problem analysis and solving appear comparatively new and most elaborate in humans. He commented that LD children can have normal executive functions. It could well be that mechanisms for dominating others, amassing property and wealth, tool use, and mating are evolutioC personal gain. Biederman's group (1996) has even reported comparable rates of drug abuse for CD and bipolar children, an overlap that occurs again when the subjects attain middle age!

12) There's the "hyperfocus myth" that Ned Hallowell attributed to ADHD and even appears in Nadeau (1996). I think "hyperfocus" more properly fits with other mania symptoms that I see and that Jamison (1996) describes so well. I sometimes wonder if a little mania is an essential LD children without ADHD can develop their own compensations for their LD problems. Children with both disorders are dependent on tutors less for teaching information and more for discovering effective learning strategies. Applying this analysis to children with both mania and ADHD suggests that ADHD may act so that the manic child also repeats his mistakes more than the same child would without ADHD. One manic father has commented, "I learned by my son's age that my family had no time for my nonsense but my son (14 years old and with ADHD in addition to probable mania) can't."

References in Part 3

• ADHD by Mark Waugh, PhD, 3/27/97
  • ADD & ADHD; Hyperfocus & Changes in Dx by James Brody, 4/1/97
    • Focal Cats by John Fentress, 3/8/98
      • Lateral Inhibition by James Brody, 3/18/98
        • A Worthy Topic by John Fentress, 3/22/98
          • Kauffman at the Cape by James Brody, 3/23/98
  • Hunters, Farmers, & Marathoners by James Brody, 4/1/97